Mean Number Of Hospitalizations Research Articles

Enhanced Comprehensive Care Programme: a retrospective study of patient empanelment by generalist-led multidisciplinary teams to reduce acute care utilisation.

Singapore faces an increasingly aged population with complex multimorbidity and psychosocial impairment. This change in demographic is challenging for existing healthcare systems. Breaks in care coordination and continuity result in poor health outcomes, increased acute care utilisation and higher healthcare costs. We proposed a patient empanelment approach adapted for the Singapore context based on the University of Chicago Comprehensive Care Physician model. This retrospective quasi-experimental, matched-controlled observational study sought to assess the effectiveness of the Enhanced Comprehensive Care Programme (ECCP) in reducing acute care utilisation at National University Hospital, Singapore. The primary outcomes were the number of hospitalisations and emergency department (ED) visits 6 months pre- and post-enrolment in ECCP. We used propensity score matching to balance prior healthcare utilisation between the intervention and control groups. Fifty-seven participants were recruited in the programme between October 2019 and April 2020. There was a reduction in the mean number of hospitalisations after intervention compared to before intervention (0.58 ± 1.03 vs. 1.90 ± 1.07, P < 0.001). There was also a reduction in the mean number of ED visits (0.77 ± 1.05 vs. 1.96 ± 1.14, P < 0.001). In the propensity-matched cohort, the mean number of hospitalisations was reduced in the intervention group (from 1.92 ± 1.07 to 0.58 ± 1.03, P < 0.001) compared to the control group (from 1.85 ± 0.99 to 1.06 ± 1.17, P = 0.04). This observational study shows the potential benefits of ECCP healthcare redesign to reduce acute care utilisation.

Impact of HCV cure on subsequent hospitalizations in people with mental disorders: Results from the French claims database

Background and Aims: Although HCV cure after direct-acting antiviral (DAA) treatment is associated with hepatic and extrahepatic benefits, few studies have assessed the impact of HCV treatment in people with mental disorders (PWMDs). Using quasi-exhaustive national data from the French administrative health care databases (SNDS), we explored whether DAA treatment in PWMDs affected hospitalizations in both psychiatric and non-psychiatric settings.Methods: All adult PWMDs identified in the SNDS with DAA treatment initiation between 2015 and 2018 and 12 months of data pre- and post-treatment were included. Individuals were algorithmically classified into one or several subgroups: “addictive disorders”, “neurotic and mood disorders”, “psychotic disorders” and “other psychiatric disorders”. A longitudinal approach was used to compare the frequency and duration of hospitalizations one year before and one year after DAA treatment.Results: In total, 17,203 individuals met the inclusion criteria. The number of patients with at least one hospitalization (any type) decreased by 28% after HCV cure. The mean numbers of hospitalizations in non-psychiatric units per patient per year were 1·2 during the pre-DAA period and 0·8 during the post-DAA period (p < 0·0001). Similarly, the number of hospitalizations in psychiatric wards decreased from 1·4 to 1·2 (p = 0.006). The duration of hospital stays decreased from 20·2 days to 16·7 days in non-psychiatric settings (p < 0·0001). These results were also homogeneous and significant across all subgroups.Conclusions: HCV cure significantly lowered the frequency and duration of hospitalizations during the year following treatment in all PWMDs subgroups, including the psychotic disorders subgroup.Funding: This study was funded by Gilead Sciences.

Difficult-to-Engage Patients with Severe Mental Illness in Rural Community Settings: Results of the Greek Hybrid Assertive Community Treatment Model of Mental Healthcare.

Background: Modified Assertive Community Treatment (ACT) in rural settings may be effective in the care of patients with severe mental illness (SMI) that are difficult to engage in community care. The objective of the present study was to explore the impact of the care by a hybrid ACT team on SMI patients' hospitalizations, length of hospital stay, symptomatology and functioning in a rural community treatment setting in Greece. Methods: The hybrid ACT team is an expansion of the services of the well-established generic Mobile Mental Health Unit in a rural area of Northwest Greece, and delivers home-based care for patients with SMI. This was a 3-year prospective, mirror image, pre-post observational study. Patients' symptomatology, functioning and general outcome were measured with the use of the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning Scale (GAF), and the Health of the Nation Outcome Scale (HοNOS). Results: The mean age of the 23 enrolled patients was 52.4 years and the mean age of disease onset was 23.5 years, with a mean number of hospitalizations 10.74. Over the 16-month follow-up patients' hospitalizations, both voluntary and involuntary, had been significantly reduced by almost 80%. Length of hospital stay had been significantly reduced by 87%, whereas patients' functioning and symptomatology had been significantly improved, by 17% and 14.5%, respectively. Conclusions: The model of hybrid ACT in rural areas in Greece may be effective in the treatment of difficult-to-engage patients with SMI and may improve patients' outcomes.

Clinical impact of remote heart failure management using the multiparameter ICD HeartLogic alert

Introduction and objectivesThe multiparametric implantable cardioverter-defibrillator HeartLogic index has proven to be a sensitive and timely predictor of impending heart failure (HF) decompensation. We evaluated the impact of a standardized follow-up protocol implemented by nursing staff and based on remote management of alerts. MethodsThe algorithm was activated in HF patients at 19 Spanish centers. Transmitted data were analyzed remotely, and patients were contacted by telephone if alerts were issued. Clinical actions were implemented remotely or through outpatient visits. The primary endpoint consisted of HF hospitalizations or death. Secondary endpoints were HF outpatient visits. We compared the 12-month periods before and after the adoption of the protocol. ResultsWe analyzed 392 patients (aged 69±10 years, 76% male, 50% ischemic cardiomyopathy) with implantable cardioverter-defibrillators (20%) or cardiac resynchronization therapy defibrillators (80%). The primary endpoint occurred 151 times in 86 (22%) patients during the 12 months before the adoption of the protocol, and 69 times in 45 (11%) patients (P<.001) during the 12 months after its adoption. The mean number of hospitalizations per patient was 0.39±0.89 pre- and 0.18±0.57 postadoption (P<.001). There were 185 outpatient visits for HF in 96 (24%) patients before adoption and 64 in 48 (12%) patients after adoption (P<.001). The mean number of visits per patient was 0.47±1.11 pre- and 0.16±0.51 postadoption (P<.001). ConclusionsA standardized follow-up protocol based on remote management of HeartLogic alerts enabled effective remote management of HF patients. After its adoption, we observed a significant reduction in HF hospitalizations and outpatient visits.

Evaluation of clinical and sociodemographic characteristics of hospitalised patients with schizophrenia spectrum disorder

IntroductionSchizophrenia and other psychotic disorders are disorders in which the individual’s assessment of reality is impaired and which progress with exacerbations and become chronic, leading to disability, loss of function, social communication problems and frequent hospitalisations.ObjectivesThe aim of our study was to evaluate the clinical and sociodemographic data of patients followed up in the outpatient clinic for psychotic disorders and hospitalized at least once in any time during their treatment.MethodsThe sample of the present study consisted of patients who were followed up in the psychotic disorders outpatient clinic of Selçuk University Faculty of Medicine Hospital and who were hospitalised at least once. Patients were identified by retrospective file search and those with sufficient information about their sociodemographic-clinical characteristics were included. The study approved by the ethics committee of Selçuk University Faculty of Medicine.ResultsOf the 130 patients, 52 (40%) were female and 78 (60%) were male; mean age was 40.8 ± 12.0 years. Almost half of the patients (n=53, 40.8%) had primary school education. 73 (59.2%) of 130 patients were receiving long-acting antipsychotic medication. 100 patients (76.9%) were using oral antipsychotics. 63 out of 100 patients were on clozapine. 22 of 63 patients used clozapine as monotherapy. The mean duration of untreated psychosis (n=90) was 15.8 ± 32.1 months. The mean number of hospitalisations was 3.4 ± 2.5. 15 patients (11.5%) were lived in a nursing home. The mean number of hospitalisations of patients receiving long-acting treatment (3.8±2.9) was significantly higher than that of patients receiving oral treatment only (2.7±1.6) (p=0.004). There was no significant difference in the mean number of hospitalisations when comparing according to the presence of clozapine in the treatment (p&gt;0.05).ConclusionsThe primary goal in the treatment of patients with schizophrenia is to prevent relapses, hospital admissions and improve patients’ quality of life and functioning. Therefore, the variables related to hospitalisations, which are an indirect indicator of the frequency of psychotic episodes, should be well evaluated. Our study was mainly descriptive and evaluated the relationship between several parameters and hospitalisations. It was thought that the high number of hospitalisations in patients on long-acting treatment might be related to the fact that long-acting treatment in our country is mostly started in the late stages of the disease. Large-sample studies of predictive parameters are needed to prevent psychotic episodes and reduce the number of hospitalisations.Disclosure of InterestNone Declared

Retrospective evaluation of sociodemographic and clinical characteristics of patients with schizophrenia receiving clozapine monotherapy and clozapine combined with different antipsychotics

IntroductionSchizophrenia is a chronic mental disorder and clozapine is an atypical antipsychotic that can be used in treatment-resistant schizophrenia patients. However, treatment-resistant schizophrenia may also include patients with an inadequate response to clozapine.ObjectivesIn our study, we retrospectively analysed the sociodemographic and clinical characteristics of patients receiving clozapine monotherapy and patients receiving clozapine in combination with different antipsychotics. In this way, we aimed to evaluate the factors that influence the response to clozapine.MethodsClozapine monotherapy and clozapine in combination with different antipsychotics were identified by retrospective chart review of patients followed up at the Schizophrenia and Other Psychotic Disorders Outpatient Clinic, Department of Psychiatry, Faculty of Medicine, Selçuk University. Sociodemographic and clinical characteristics were recorded and subjected to statistical analysis. The study was approved by the Ethics Committee of Selçuk University.Results Of the 143 patients whose data were analysed, 60 (42%) were female. The mean age of the patients was 40.2±12.0 years and the mean duration of training was 10.4±4.3 years. 62 patients (43.4%) used long-acting antipsychotics. 90 patients (62.9%) were using clozapine, 52 (36.4%) were using clozapine as monotherapy, 5 (3.5%) were using clozapine together with another oral antipsychotics drug, and 33 (23.1%) were using clozapine together with a long-acting antipsychotic. No statistically significant difference was found when comparing mean age, age at first antipsychotic initiation, age at clozapine initiation and mean clozapine dose between patients using clozapine monotherapy (n=52) and patients using different antipsychotics in combination with clozapine (n=38). When the two groups were compared, a significant difference was found in the mean number of antipsychotics used before starting clozapine and the mean number of hospitalisations, with a lower number in the monotherapy group (3.1±1.4 vs 4.1±2.0, p=0.01 and 2.8±2.2 vs 4.5±3.2, p=0.006, respectively).ConclusionsIt is important to assess the concept of treatment resistance appropriately in the treatment of schizophrenia patients. The results of our study suggest that starting clozapine treatment promptly in treatment-resistant patients may increase the likelihood that patients will benefit from clozapine and reduce the need for additional treatments. Although our data and criteria for evaluating response to treatment are limited, it is important to draw attention to the clinical results of proceeding in accordance with the guidelines in the treatment of schizophrenia. Evaluating the response to clozapine treatment needs studies with stronger data and larger sample sizes.Disclosure of InterestNone Declared

Reductions in hospitalisations and emergency department visits with early antibiotic initiation in nontuberculous mycobacterial lung disease.

While antibiotics are recommended for treatment of nontuberculous mycobacterial lung disease (NTMLD), the impact of early antibiotic initiation on healthcare resource utilisation is unclear. This study compared healthcare resource utilisation with early versus delayed antibiotic initiation in NTMLD. A retrospective, claims database study (Merative MarketScan) of patients diagnosed with NTMLD between 1 July 2015 and 30 June 2019. Patients were divided into early antibiotic initiation, i.e. ≤3 months after the first medical claim for NTMLD (index date), and delayed antibiotic initiation groups. Hospitalisations and outpatient visits during a 2-year post-index period were compared to baseline per treatment group; a difference-in-difference analysis compared early and delayed antibiotic initiation groups adjusting for confounding. Out of 481 NTMLD treated patients, 364 (76%) and 117 (24%) comprised the early and delayed antibiotic initiation groups, respectively. The early antibiotic initiation group showed significant reductions from baseline in hospitalisations (all-cause, respiratory) and emergency department (ED) visits at follow-up. A significant increase from baseline in mean number of hospitalisations per patient was observed in the delayed antibiotic initiation group in year 1 post-index. Compared to delayed antibiotic initiation, the early antibiotic initiation group showed significantly greater reductions in all-cause hospitalisations in years 1 and 2 post-index (relative risk 0.62 (95% CI 0.41-0.95) and 0.62 (95% CI 0.39-0.98), respectively), and in respiratory-related hospitalisations. The early antibiotic initiation group showed significant reductions from baseline in hospitalisations and ED visits over time. Compared to delayed antibiotic initiation, early antibiotic initiation was associated with significantly greater reductions in hospitalisations.

Impact of Adjunctive VNS on Drug Load, Depression Severity, and Number of Neuromodulatory Maintenance Treatments.

Vagus nerve stimulation (VNS) is a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD). A total of n = 20 patients (mean age 52.6 years) were included in the multicenter, prospective, observational, naturalistic RESTORE-LIFE study and were treated with adjunctive VNS as an add-on to treatment as usual. Exploratory and secondary outcome parameters from a single center were investigated for this present analysis. The overall mean drug load slightly decreased from 4.5 at baseline to 4.4 at 12 months (Z = -0.534, p = 0.594). The drug load was lower in previous electroconvulsive therapy (ECT) responders than in non-responders. There was a reduction in the mean number of hospitalizations per month after VNS implantation (Z = 1.975, p = 0.048) and a significant decrease in the mean Montgomery Åsberg Depression Rating Scale (MADRS) score from 27.3 at baseline to 15.3 at 12 months (T = 4.230, degree of freedom (df) = 19, p = 0.001). A history of ECT response at baseline was associated with greater improvement in the MADRS score after 12 months of VNS (F = 8.171, p = 0.013). The number of neuromodulatory maintenance treatments decreased during the follow-up period. In summary, there was an alleviation in the burden of illness among DTD patients treated with VNS.

Compliance and rehabilitation effects of Zheng's supine rehabilitation exercise performed at home among patients with chronic obstructive pulmonary disease: a retrospective study.

Zheng's supine rehabilitation exercise (ZSRE) can be performed by elderly patients with the acute exacerbation of severe or extremely severe chronic obstructive pulmonary disease (COPD) with high safety and compliance and was helpful for their recovery. Investigation is warranted of the compliance and rehabilitation effects of ZSRE performed at home in patients with COPD. We performed telephone interviews with 157 patients with COPD who were hospitalized on the 26th floor of the National Clinical Research Center for Respiratory Disease and who received COPD education and ZSRE training from 1 September 2015 to 31 August 2016. We retrospectively analyzed the patients' compliance with performing ZSRE at home after discharge and the frequency of hospitalization for treatment of acute exacerbation in both the previous and subsequent years. Among the 157 patients, 66 failed to complete home ZSRE after discharge (non-rehabilitation group), 41 performed home ZSRE once a day after discharge (one-session rehabilitation group), and 50 performed home ZSRE at least twice a day after discharge (multiple-session rehabilitation group). The home ZSRE compliance rate was 57.96% (91/157). There were no significant differences in the mean number of hospitalizations in the year prior to receiving COPD education and ZSRE training among the non-rehabilitation group (1.06±0.75), one-session rehabilitation group (1.27±0.78), and multiple-session rehabilitation group (1.16±0.91). However, there was a significant difference in the mean number of hospitalizations among the groups in the year following discharge (1.44±1.17, 0.78±0.82, and 0.66±0.75, respectively). The number of hospitalizations significantly increased in the non-rehabilitation group and significantly decreased in the one- and multiple-session rehabilitation groups. Home ZSRE can be performed with high compliance by elderly patients with severe or extremely severe COPD and can reduce the number of readmissions.

5 Hospitalization Outcomes Following Neuropsychological Evaluation in a Traumatic Brain Injury Sample

Objective:Previous research has shown that positive outcomes are associated with receiving a neuropsychological evaluation (NPE). The current project examined hospitalization outcomes following an NPE in a sample of patients who had sustained a traumatic brain injury (TBI). Hospitalization rates were compared between the two years pre- and two years post-evaluation. The role that insurance status plays on these health outcomes was also examined. This project is part of a growing effort to evaluate outcomes of clinical neuropsychological services in order to better characterize the broad health impacts of NPEs.Participants and Methods:Participants for the current study come from the Optum® de-identified Electronic Health Record dataset. The final sample included 245 patients who completed at least one NPE and were diagnosed with a TBI, according to ICD codes associated with their healthcare records. Patients were aged 21-87 (M = 51.55, SD = 16.74) with an average Charleston Comorbidity Index of 1.77 (SD = 2.41). The sample consisted of 124 females (50.6%), 121 males (49.4%). The majority of the sample identified as non-Hispanic white (N = 213; 86.9%), while 8.6% identified as another race or ethnicity. Regarding insurance, the most common insurance type was commercial (61.6%), followed by Medicare (13.5%), Medicaid (9.4%), and uninsured (6.5%). Those with unknown insurance status, race, or ethnicity were excluded from analyses of those variables.Results:Hospitalization incidence for the sample was significantly lower in the two years following a NPE, X2(1, N = 245) = 26.98, p &lt; .001, compared to the two years prior. The mean number of hospitalizations were also lower following a NPE (t(244) = 4.83, p &lt; .001). Insurance status did not show a significant main effect or interaction on mean number of hospitalizations over time. Regarding demographic variables, there was no significant main effects of race/ethnicity group or interaction between race/ethnicity and hospitalization rate change over time. However, there was a significant interaction between hospitalization rate change over time and gender (F(242) = 4.74, p = 0.030). A significant decrease in hospitalizations over time was seen for males (p &lt; .001), while females showed a trend-level decrease that approached significance (p = .06).Conclusions:Consistent with previous research, significant reductions in hospitalization incidence and mean number of hospitalizations were seen following a NPE. This finding did not vary based on insurance status. However, hospitalization outcomes varied as a function of gender. These findings suggest that completing a NPE following a traumatic brain injury may contribute to improved hospitalization outcomes, but it does not appear that this benefit is seen equally for all patients. Insurance status may play a role in accessibility to care and hospitalization outcomes in this population, but that relationship is likely influenced by other factors, including racial identity, gender, and income. Future research is needed to investigate the extent that NPEs impact hospitalization rates in the broader context of insurance, demographic factors, and socioeconomic status.

Phenotype fingerprinting of bipolar disorder prodrome

BackgroundDetecting prodromal symptoms of bipolar disorder (BD) has garnered significant attention in recent research, as early intervention could potentially improve therapeutic efficacy and improve patient outcomes. The heterogeneous nature of the prodromal phase in BD, however, poses considerable challenges for investigators. Our study aimed to identify distinct prodromal phenotypes or "fingerprints" in patients diagnosed with BD and subsequently examine correlations between these fingerprints and relevant clinical outcomes.Methods20,000 veterans diagnosed with BD were randomly selected for this study. K-means clustering analysis was performed on temporal graphs of the clinical features of each patient. We applied what we call “temporal blurring” to each patient image in order to allow clustering to focus on the clinical features, and not cluster patients based upon their varying temporal patterns in diagnosis, which lead to the desired types of clusters. We evaluated several outcomes including mortality rate, hospitalization rate, mean number of hospitalizations, mean length of stay, and the occurrence of a psychosis diagnosis within one year following the initial BD diagnosis. To determine the statistical significance of the observed differences for each outcome, we conducted appropriate tests, such as ANOVA or Chi-square.ResultsOur analysis yielded 8 clusters which appear to represent distinct phenotypes with differing clinical attributes. Each of these clusters also has statistically significant differences across all outcomes (p < 0.0001). The clinical features in many of the clusters were consistent with findings in the literature concerning prodromal symptoms in patients with BD. One cluster, notably characterized by patients lacking discernible prodromal symptoms, exhibited the most favorable results across all measured outcomes.ConclusionOur study successfully identified distinct prodromal phenotypes in patients diagnosed with BD. We also found that these distinct prodromal phenotypes are associated with different clinical outcomes.

Outcome analysis on individual health budgets in mental Health: finding from the Friuli Venezia Giulia Region, Italy

Background Individual Health Budget (IHB) is used for social and health integration and to facilitate processes of resource reorientation in healthcare. Despite its increased use in mental health settings, few studies investigated its effectiveness in severe mental disorders. Methods 383 IHB beneficiaries were recruited among Mental Health Departments users of the Italian region Friuli Venezia Giulia. Data involved sociodemographic and clinical variables, IHB type and scores of Health of the Nation Outcome Scale (HoNOS) at admission to IHB programme (T0), after 12 months (T1), and after 24 months (T2). Results The length and the mean number of hospitalisations and healthcare interventions decreased at T1. A significant scores’ reduction from T0 to T1 evaluation was found in HoNOS total score (T-test (P) < 0.05) and in most of its items. An improvement throughout the whole evaluation period (T0 vs. T2) was found in 36% of the IHB beneficiaries, while more than 60% of them remained in the same HoNOS severity category. Conclusions Our results support the use of IHB in patients with severe mental problems, since it may contribute to an improvement in social and clinical functioning, consequently lowering the burden on MHDs.

PO-01-218 AFRICAN AMERICAN PATIENTS WITH AF AND OBESITY HAVE HIGHER COMORBIDITIES AND MORTALITY RATES THAN THEIR WHITE COUNTERPARTS

Race and socio-economic status can have a significant impact on health outcomes in patients with AF and obesity. We sought to compare the burden of cardiovascular comorbidities, the number of hospitalizations, and the death rate, between African American and white patients with obesity and AF over a 10 year follow-up period We searched the Research Action for Health Network (REACHnet) database for AF patients in Louisiana, diagnosed and followed-up between the years 2010 and 2019. Of the initial 6000 AF patients, we selected the patients who had obesity (all categories). A total of 1179 African American and 1355 white patients were compared for cardiovascular comorbidities, number of hospitalizations, death rates, as well their median household income (MHI). Although younger in age, African American patients with AF and obesity, had significantly higher rates of comorbidities notably: hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, and heart failure, in comparison to white patients (P< 1e-04) (Table). Over the 10 year follow-up period, their mean number of hospitalizations was 8.61 Vs 2.94 in whites (P< 1e-04). Mortality rates were nearly doubled in African American patients (< 1e-04) (Table). African American patients earned less than half of their white counterparts with an average MHI of 28590 ± 8881.31 USD per year Vs. 60547.15 ± 15944.61 USD per year. (P< 1e-04) African American patients with AF and Obesity have lower MHI, a significantly higher burden of cardiovascular comorbidities, more hospitalizations, and nearly double the death rate, in comparison to white patients.Tabled 1Comorbidities, hospitalizations, and death in African American Vs White patients with AF and obesityAfrican Americans N=1179Whites N=1355P valueAge mean (SD)61.14 (11.60)64.92 (9.66)< 1e-04Sex M:F1.042.53< 1e-04Hypertension89%76.9%< 1e-04Diabetes62.4%41.3%< 1e-04Hyperlipidemia69%53.1%< 1e-04Heart Failure34.6%18.5%< 1e-04Coronary Artery Disease40.2%23.6%< 1e-04Stroke12%5%< 1e-04Sleep Apnea30.8%24.5%0.0004COPD25.4%16.2%< 1e-04No. of Hospitalizations Mean (SD)8.61 (15.84)2.94 (5.52)< 1e-04Death9.6%4.7%< 1e-04 Open table in a new tab

Adjunctive short- and long-term combination treatment of esketamine and VNS in difficult to treat depression (DTD)

IntroductionNMDA-Receptor antagonists have rapid antidepressant and antisuicidal properties. However, the antidepressant effect is short lasting raising the question of best maintenance strategy, which is unanswered so far. Invasive vagus nerve stimulation (VNS) as a treatment option for refractory and chronic major depression was shown to reduce the need of maintenance treatment sessions in electroconvulsive therapy (ECT) patients.ObjectivesThere are no published data on the combination of VNS and esketamine. To determine the impact of the combination of VNS and esketamine in DTD.MethodsIn this naturalistic observational study, we investigated the short- and long-term impact of combination of VNS and esketamine in n=8 patients with difficult-to-treat depression (DTD). Follow-up evaluations were scheduled prospectively pre-surgery at baseline and every 3 months after VNS-implantation (follow-up period 12-24 months, mean 17).ResultsThe mean age of patients was 50,8 years. 50 % of patients (n=4) were female. All patients suffered from severe DTD (mean MADRS at baseline 30,9). Mean number of hospitalizations per months decreased from 0.17 to 0.11 after VNS implantation. 6 of 8 patients were offered maintenance esketamine treatment. Mean MADRS at 12-months was 19 (38.5 % MADRS reduction). The need of mean esketamine treatment sessions decreased from 2.3 at 6-months visit (V6) to 1.37 at V9 and 0.96 at V12 respectively. Termination of maintenance esketamine was possible in 4 cases after a mean of 11.5 months.ConclusionsCombination of esketamine and VNS is a safe and effective treatment option in severely ill DTD patients to relieve disease severity and reduce hospitalizations. Need of esketamine treatment sessions decreases 6 months after VNS implantation.Disclosure of InterestNone Declared

Effectiveness of Paliperidone Palmitate in Reducing Acute Psychiatric Service Use for Patients Suffering from Psychosis-A Retrospective Mirror-Image Study.

Poor adherence to antipsychotic treatment is a leading cause of relapse for patients suffering from psychotic disorders and the use of long-acting injectable antipsychotics (LAI) may lead to improved clinical outcomes. This was a 1-year mirror-image study examining the clinical outcomes after monthly administration of paliperidone palmitate (PP1M). The primary outcome measure was the total days of psychiatric hospitalization in the 1-year before and 1-year after initiation of PP1M. Data from 158 patients were included in the study. Most of the patients suffered from schizophrenia. In the year after initiation of PP1M, the mean number of hospitalization days fell from 106.53 to 19.10 (p < 0.001). There were significant reductions in the mean number of hospitalizations and emergency room visits. The use of paliperidone palmitate is associated with significant reduction in both the number of admissions and days of psychiatric hospitalization.

Excess hospitalizations and mortality associated with seasonal influenza in Spain, 2008–2018

BackgroundInfluenza may trigger complications, particularly in at-risk groups, potentially leading to hospitalization or death. However, due to lack of routine testing, influenza cases are infrequently coded with influenza-specific diagnosis. Statistical models using influenza activity as an explanatory variable can be used to estimate annual hospitalizations and deaths associated with influenza. Our study aimed to estimate the clinical and economic burden of severe influenza in Spain, considering such models.MethodsThe study comprised ten epidemic seasons (2008/2009–2017/2018) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD codes in time-series models, computed for six age groups and four groups of diagnoses: pneumonia or influenza (ICD-9: 480–488, 517.1; ICD-10: J09–J18), respiratory (ICD-9: 460–519; ICD-10: J00–J99), respiratory or cardiovascular (C&R, ICD-9: 390–459, 460–519; ICD-10: I00–I99, J00–J99), and all-cause. Means, excluding the H1N1pdm09 pandemic (2009/2010), are reported in this study.ResultsThe mean number of hospitalizations with a diagnosis of influenza per season was 13,063, corresponding to 28.1 cases per 100,000 people. The mean direct annual cost of these hospitalizations was €45.7 million, of which 65.7% was generated by patients with comorbidities. Mean annual influenza-associated C&R hospitalizations were estimated at 34,894 (min: 16,546; max: 52,861), corresponding to 75.0 cases per 100,000 (95% confidence interval [CI]: 63.3–86.3) for all ages and 335.3 (95% CI: 293.2–377.5) in patients aged ≥ 65 years. We estimate 3.8 influenza-associated excess C&R hospitalizations for each hospitalization coded with an influenza-specific diagnosis in patients aged ≥ 65 years. The mean direct annual cost of the estimated excess C&R hospitalizations was €142.9 million for all ages and €115.9 million for patients aged ≥ 65 years. Mean annual influenza-associated all-cause mortality per 100,000 people was estimated at 27.7 for all ages.ConclusionsResults suggest a relevant under-detected burden of influenza mostly in the elderly population, but not neglectable in younger people.

Healthcare consumption in congenital heart disease: A temporal life-course perspective following pediatric cases to adulthood

BackgroundImprovements in diagnosis, intervention, and care of congenital heart disease (CHD) have led to increased survivability and lifelong dependence on healthcare. This study aims to determine the extensiveness of inpatient care episodes across different life-stages and CHD severity compared to matched controls, and to explore how healthcare utilization among pediatric CHD cases have changed over time. MethodologyNational registry data was used to conduct a 1:9 matching analysis with age and sex matched controls. Then, Poisson timeseries analysis was used to conduct trend analysis for inpatient healthcare utilization among pediatric cases <18 years of age. ResultsMost CHD cases were non-complex (87.3%), with highest hospitalization rates occurring in infancy. Mean number of hospitalizations among complex cases were over twice that of non-complex cases. Also, as age progressed, mean hospitalization for non-complex cases began converging to the control population. In terms of trend analysis within this study period, healthcare utilization increased by 34% among the infant categories, but decreased by 12% and 32% among children between 1-9 years and 10–17 years, respectively. Also, utilization was not trending in one direction substantiating the claim that multiple time periods are required to assess temporal changes within this population. ConclusionInpatient healthcare utilization among the CHD population appears to be decreasing over time in most cases, where non-complex cases transitioning to adult care are increasingly converging to the general population. Additionally, this study validates the need to use multiple time-periods when conducting longitudinal studies across the CHD population.

1450. Trends in hospitalizations and outpatient visits with early or delayed antibiotic treatment initiation in nontuberculous mycobacterial lung disease

Abstract Background The 2020 treatment guidelines for patients diagnosed with nontuberculous mycobacterial lung disease (NTMLD) recommend antibiotic treatment initiation rather than “watchful waiting” for most patients. Little is known regarding how delayed treatment (DT) may impact healthcare resource utilization (HRU). The goal of this study was to assess HRU with early antibiotic treatment (ET) or DT in NTMLD. Methods We conducted a retrospective observational cohort study using MarketScan claims from July 2014 to June 2020. Inclusion criteria were: ≥ 2 NTMLD medical claims (with date of first NTMLD claim as index date); continuous enrollment spanning 12 months pre–index date (baseline) to ≥ 24 months post–index date; concomitant treatment with antibiotics used in NTMLD, ie, from ≥ 2 drug classes within 28 days of each other; and no tuberculosis diagnosis. Mean time to antibiotic initiation (TT) from index date was used to define ET (TT ≤ 3 months) and DT (TT &amp;gt; 3 months) groups. Trends in hospitalizations (any, respiratory-related) and any outpatient visits at baseline, year 1 (Y1), and year 2 (Y2) post–index date were described. Results A total of 518 patients with NTMLD were included: 395 (76%) ET and 123 (24%) DT patients. ET patients tended to be younger and male; DT patients had a higher prevalence of emphysema, asthma, and bronchiectasis. ET patients had a decrease from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1 and Y2 (Figure 1A and 1B). DT patients had an increase from baseline in the proportion of patients hospitalized and the mean number of hospitalizations at Y1, followed by a decrease in Y2, although the mean number of hospitalizations at Y2 remained higher than at baseline. Similar trends in respiratory-related hospitalizations were observed per patient group (Figure 1C and 1D). ET patients had a decrease from baseline in the proportion of patients and the mean number of emergency room visits at Y1 and Y2, whereas DT patients showed little to no improvement (Figure 2A and 2B). Figure 1.Proportion of patients with (A) any hospitalization and (C) respiratory disease–related hospitalizations with early or delayed treatment for NTMLD. Mean number of (B) any hospitalizations and (D) respiratory disease–related hospitalizations per patient with early or delayed treatment for NTMLDFigure 2.(A) Proportion of patients with any ER visits with early or delayed treatment for NTMLD. (B) Number of ER visits per patient with early or delayed treatment for NTMLD Conclusion During the first 2 years after diagnosis, improvements in hospitalizations and ER visits were observed in patients who received ET, whereas patients who received DT showed little to no improvement from baseline. Disclosures Kevin L. Winthrop, MD, MPH, AN2: Advisor/Consultant|AN2: Grant/Research Support|Insmed: Advisor/Consultant|Insmed: Grant/Research Support|Paratek: Advisor/Consultant|Paratek: Grant/Research Support|Red Hill Biopharma: Advisor/Consultant|Red Hill Biopharma: Grant/Research Support|Spero Therapeutics: Advisor/Consultant Catherine Waweru, PhD, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Mariam Hassan, PhD, B. Pharm, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds Sara Burns, MS, Panalgo: Employee Anjan Chatterjee, MD, MPH, Insmed Incorporated: Employee|Insmed Incorporated: Stocks/Bonds.

Results from PSIPROSPER: A multicenter retrospective study to analyze the impact of treatment with paliperidone palmitate 1-month on clinical outcomes and hospital resource utilization in adult patients with schizophrenia in Portugal.

Schizophrenia is a chronic psychiatric disorder with a significant impact worldwide. The early onset and its relapsing nature pose a significant challenge to patients and caregivers. The PSIPROSPER study aimed to characterize the real-world context of schizophrenia treatment in Portugal and to measure the impact of including paliperidone palmitate 1-month formulation (PP1M) in the clinical outcomes (relapses and hospitalizations) and healthcare resource utilization, in a context in which payment scheme in Portugal allows for patients to receive free antipsychotics if prescribed at public hospitals. This was a multicenter, retrospective, observational study. Male and female adults with a diagnosis of schizophrenia who initiated treatment with PP1M after a minimum of 12 months on an Oral Antipsychotic (OAP), and with complete medical charts, were consecutively included. A mirror-image design over 24 months allowed the comparison of outcomes before and after the PP1M introduction. Out of the 51 patients included, 80.4% were male, with a mean age of 34 (±9.8) years. Around 92% of patients were being treated with PP1M at inclusion. Lack of adherence to previous OAP was the main driver for PP1M initiation. Only 9.8% of patients were hospitalized during the PP1M period vs. 64.7% during the OAP period (p < 0.0001). The mean number of hospitalizations (0.1) was significantly lower during the PP1M period (p < 0.0001). Type of treatment was the only variable found to be significant in predicting a lower hospitalization rate and a lower risk of hospitalization. Relapses were significantly lower (p < 0.0001) in PP1M (21.6%) vs. OAP (83.7%). Similarly, the mean change in the number of relapses (p < 0.0001) showed significantly better outcomes in PP1M. This study supports PP1M as part of schizophrenia treatment in Portugal. Given the lower number of relapses and hospitalizations observed in schizophrenia patients treated with PP1M when compared to OAP-treated patients, this real-world study seems to provide further evidence to support the use of PP1M to treat this condition, in line with previous research. In the context of scarce public resources, these benefits should be carefully considered by healthcare decision-makers to ensure optimal value-based treatment strategies.

Burden of congenital hemophilia A requiring treatment in Japan: The HIKOBOSHI study

BackgroundTreatment of congenital hemophilia A (HA) in Japan has greatly improved with the widespread adoption of prophylactic factor (F)VIII concentrates. However, it is unknown ifhas translated into a real‐world reduction in disease and treatment burden. ObjectivesTo describe HA disease burden in Japan based on information from two medical information databases, JMDC and Real World Data Co., Ltd. (RWD). MethodsEligible individuals were diagnosed with congenital HA and prescribed FVIII concentrates, bypassing agents, or emicizumab. Treatment patterns and disease burden data were derived from health insurance claims and electronic medical records. ResultsData on 459 people with HA were retrospectively collected from 2005 to 2020 in the JMDC database (median [min, max] of 37 [2, 186] months of available records), and 229 people with HA from 1985 to 2020 in the RWD database (median [min, max] of 154 [0, 409] months of available records). Mean (standard deviation) ages at the time of the first record were 25.0 (16.8) years (JMDC) and 19.2 (20.3) years (RWD). In the JMDC database, mean monthly FVIII dose increased from 2201 IU in 2005 to 8239 IU in 2013 to 11,377 IU in 2019; HA‐related drug costs increased accordingly. Mean (95% confidence interval) annual outpatient and out‐of‐hours visits decreased slightly between 2013 and 2019 (outpatient visits: from 22.9 [16.8–29.0] to 14.3 [12.6–16.1] per person; out‐of‐hours visits: from 1.3 [0.2–2.5] to 0.6 [0–1.4]). There was no change in mean number of hospitalizations. ConclusionsChallenges remain in HA, including treatment burden, outpatient visits, and hospitalizations.